The Health and Social Care Information Centre (HSCIC) have
today (22nd May) published two updates of statistics about people
with learning disabilities in inpatient services in England. Both of these
updates are based on information from English NHS commissioners, and are
re-booted updates in a series previously published by NHS England.
The first update contains a range of information on the
number of people in learning disability inpatient services from February to
March 2015 (it’s not information for a full three months because the
responsibility for collecting the information moved from NHS England to HSCIC
in January). It’s available here http://www.hscic.gov.uk/catalogue/PUB17638/lds-1415q4-rep.pdf
The second update contains similar information (in less
detail) on a month-by-month basis, reporting on the month of April 2015. This
is available here http://www.hscic.gov.uk/catalogue/PUB17634/ldsm-apr-15-exec.pdf
There is more detail in both of them than I’m going to
mention here, and I would recommend spending a bit of time looking at both
updates if this is important to you. There are a few things that jumped out at
me, mainly because they suggest that, as yet, large-scale reductions in the use
of inpatient services are just not happening.
First, the headline figures: the number of people in
learning disability inpatient services. I found this graph from the monthly
update the most helpful: ignoring the blip in January 2015 (probably due to the
transfer of data-gathering responsibilities) the picture is of a consistent
number of people in these services from March 2014 to April 2015 (in fact the
number of people went up slightly from March to April).
Second, the population of people in these inpatient services
is pretty static. During February and March 2015, only 25 people had gone into
and come out of a specialist service in that time, a further 105 people had
been admitted and 180 people had been discharged. When admissions and
discharges can be include transfers between different inpatient services, a lot
of the admissions and discharges are likely to be people being churned around
the inpatient system. Even when just looking at how long people had been in
their current inpatient service, nearly half (47%) of people had been in their
current inpatient service for more than 2 years.
Third, there seems to be little evidence that inpatient
services are sharpening up their act in terms of what might be obvious
priorities. So at the end of March 2015:
·
there were still 110 people aged under 18 in
inpatient services,
·
there were 90 people in learning disability
inpatient services recorded as having neither a learning disability nor autism,
·
there were 285 people in inpatient services not
under the Mental Health Act,
·
almost a quarter of people (22%) had not been
reviewed in the last six months,
·
half of people (50%) still had no planned
transfer date,
·
for almost half of people (48%), their planned
transfer date was more than a year away,
·
the above statistic might partly explain why local
authorities were apparently not aware of the transfer of 755 people (32%).
Given that a large majority (79%) of people are in general
or low secure inpatient services, what are the apparent blockages to moving
people out of inpatient services? According to people’s “care plans”, of the
1,480 people “needing inpatient care”: 510 people (21%) are “not dischargeable”,
945 people (39%) have an “active treatment plan”, and only 25 people (1%)
require “indefinite inpatient care”.
This leaves 915 people (over a third of people in inpatient
units, 38%) currently in inpatient services who “do not need inpatient care”
according to their care plans, with 830 people “working towards discharge” and
85 having a “delayed transfer of care”. This number of people roughly
corresponds to the 37% of people with a planned discharge date in the next 6
months, so if this cohort moves out of inpatient services (and is not replaced
by new people) it should become visible in these statistics in the next 6
months.
Overall, while there improvements in what commissioners say
they and providers are doing (for example in the number of people with plans to
move out of inpatient units), as yet there is very little evidence that this is
resulting in more people moving out of inpatient services, of fewer people
moving in, and of inpatient services really changing what they’re doing. I also worry whether a cohort of 'easier' people are preparing to move out, with everyone else being prepared to be left where they are as 'undischargeable'. Let’s hope
they are collectively feeling the heat from NHS England, to take One Step Beyond
(see, I got there in the end – enjoy this https://www.youtube.com/watch?v=N-uyWAe0NhQ
).
